Procalcitonin to predict bacterial coinfection in infants with acute bronchiolitis: a preliminary analysis. (Petrillo)

Laham JL, Breheny PJ, Gardner BM, Bada H. Procalcitonin to predict bacterial coinfection in infants with acute bronchiolitis: a preliminary analysis. Pediatr Emerg Care. 2014 Jan;30(1):11-5.

OBJECTIVE: The aim of this study was to conduct a preliminary analysis of serum procalcitonin (PCT) to predict bacterial coinfection in infants with acute bronchiolitis.

METHODS: Retrospective cohort chart review of 40 infants admitted with acute bronchiolitis to the pediatric intensive care unit. Logistic regression models were used to determine the association of PCT and white blood count with presence of bacterial coinfection defined by either positive culture or chest radiograph result.

RESULTS: Fifteen (38%) of 40 patients had a diagnosis of bacterial coinfection by positive culture (9/15) or chest radiograph (6/15). Procalcitonin (P < 0.0001) was significantly associated with bacterial coinfection. A cutoff value of 1.5 ng/mL had sensitivity of 0.80, specificity of 1.00, and area under the operating curve of 0.88. White blood count (P = 0.06) was borderline significant with sensitivity of 0.33, specificity of 0.96, and area under the operating curve of 0.67. Three of 15 patients were later found to have bacterial coinfection with initial PCT of less than 1.5 ng/mL. None had follow-up PCT measurements taken. Thirty-five of 40 were prescribed empiric antibiotic therapy, including 20 of 25 patients without evidence of bacterial coinfection. None had a PCT of greater than 1.5 ng/mL. If a PCT cutoff of greater than 1.5 ng/mL had been used, 57% fewer patients would have received antibiotics with a 45% reduction in antimicrobial charges.

CONCLUSIONS: An elevated PCT may assist clinicians in determining presence of bacterial coinfection at admission in infants with acute bronchiolitis. Implementation of a PCT cutoff of 1.5 ng/mL at admission may prevent unnecessary antibiotic use with associated cost savings. Serial PCT levels may increase sensitivity. Further validation is warranted.

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Laundry detergent “pod” ingestions: a case series and discussion of recent literature. (Petrillo)

Pediatr Emerg Care. 2013 Jun;29(6):743-7. PMID: 23736069

OBJECTIVES: The objectives of this study were to present and explore the clinical presentation of the increasingly common pediatric exposure to the widely available single-use laundry packets or “laundry pods.”

METHODS: This is a case report of 4 pediatric patients with significant toxicity due tolaundry pod detergent exposure and a review of the available literature including abstract-only publications.

RESULTS: An unexpectedly severe clinical pattern was noted; 3 of the 4 children required intubation for management, airway injury was noted in 1 of them, and 2 of them had hospital courses of at least 1 week. The literature suggests that laundry pod exposures are associated with increased morbidity compared to traditional laundry detergent exposures. To date, no specific contaminant or component has been identified as being responsible for the injury, although some evidence points to the surfactant component.

CONCLUSIONS: A different approach to the triage and management of pediatric exposures to laundry detergent pod ingestions is required compared with nonpodingestions. Although the exact cause is not known, practitioners should be vigilant for rapid onset of neurological impairment and inability to protect the airway in addition to its caustic effects.

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